Editor’s note: This commentary originally was published within the Veterinary Information Network (VIN), a private online community, because it speaks to emotional tensions familiar to veterinarians but possibly unfamiliar to those outside the profession. Readers have since asked to share the article widely in hopes of fostering greater public understanding of the challenges sometimes faced by providers of medical care for animals. In response to these requests, the article is now freely accessible online.

The recent suicide of Dr. Shirley Koshi has triggered a multitude of swift and empathic responses. On a message board of the Veterinary Information Network and elsewhere, clinicians, students, staff members and even the public have reacted, often vehemently, to the tragic end of a veterinarian who was pummeled online and squeezed by the all-too-familiar vises of financial woes and overwhelming personal stressors.

After her involvement with an ill stray cat last August, Shirley found herself caught in a contentious battle with local cat rescuers, and saw her fledgling solo clinic in the Bronx picketed. The conflict became fodder for several social media sites, and her reputation was sullied. Shirley reportedly was found dead of an apparent suicide on Feb. 16. She was 55.

Many of us identify with her story, although perhaps in different ways, depending on life experiences. Some know the sting of defamatory online reviews. Others have been at loggerheads with animal rescue organizations. Some are familiar with the loneliness of depression and its frightening downward spiral. Still others feel underappreciated and unrecognized for their daily efforts. Some clinicians struggle with new clinics in a still-untrustworthy economy. The potential impact of such pressures isn’t a secret. Numerous studies point to an elevated risk of suicide among veterinarians. Whatever aspect of Shirley’s experience resonates, her story has laid bare our personal vulnerabilities.

As a therapist, I do not believe that there can be a “positive spin” to suicide. However, I do think that Shirley’s death may have lifted the lid, so to speak, on a Pandora’s box of psychosocial issues affecting our profession. As a result, we may have collectively arrived at the place where we can openly discuss what makes us angry and unhappy, and what fosters resentment and hopelessness. This will involve more than venting, because in the process, we may need to confront some hard realities about how we view ourselves and our chosen profession.

For starters, we need not look for emotional validation from the public about what we do. While it’s nice to get recognition and it’s frustrating when “thanks” is uncommonly heard, the fact is that it’s difficult for anyone not involved in a particular line of work to understand and empathize with the inherent stressors, the financial burdens and the personal sacrifices that are made. People outside of the profession don’t have the information to make the connection, and the truth is that empathy consequently is often tough to come by. To test this concept, try to imagine the physical and emotional stressors of the last grocery store checkout person with whom you interacted. How easy and fulfilling do you think was that person’s day or life? I submit that most of us would have difficulty knowing.

Our first job is to believe in what we do regardless of outside affirmation. Some days, we’ll be able to take solace in the fact that we didn’t “quick” a patient during his nail trim. Other days, we’ll bask in our ability to stabilize a fragile ketoacidotic diabetic. Each would need to be enough, and each is a valid victory. For sure, there will be clients who will drop us a note of gratitude, or tell others in the reception room, “S/he’s the best!” (while looking our way), or send a bucket of popcorn or chocolates for the holidays. But regardless of what others think or say, we may approach and consider our work with the self-knowledge and belief that what we do counts, because it does.

Secondly, we could care differently, or at least consider why and how much we care. This may seem heretical. After all, many of us believe that we “care more” than those in many other professions, and we wear that caring as a badge of honor. For some of us, however, caring has become a crown of martyrdom. Maybe it’s time to see ourselves more as professionals who examine, evaluate and offer recommendations and options for care rather than as pseudo-pediatricians. This does not denigrate us or the services we provide, but rather moves us to a place that I refer to as “detached attachment.”

Being involved, mindful and engaged but not neurotically enmeshed and attached to client decisions or patient outcomes is a refreshing way to work. In the end, we can do only what time and resources allow. Sometimes our clients’ finances and desires are the limiting factors, but we are myopic if we fail to recognize that sometimes we are the limiting factor, due to an incomplete knowledge base, a bad day when we’re not on our game, a lack of available staff or our hospital’s finite resources. We cannot be all things to all patients and clients at all times, and we need to embrace that self-compassionate awareness.

Despite the fact that many, if not most, of us entered veterinary medicine to care for animals, the truth is that our days involve heavy contact with humans. The overwhelming majority of those with whom we interact are not insane, mean, stupid or uncaring. If we go into our days thinking the worst about those whom we meet (and who will eventually pay the bill), we set up a “them” and “us” mentality. Wariness and disdain for others usually is hard to hide. People feel it, although we may in delusion think that we hide it well.

Because we work with people, we’ll meet some percentage whom we like, some we are ambivalent about and others whom we consciously dislike. And it will work both ways: We’ll have clients who think we can part the seas; others who connect us only with an annual rabies vaccination; and those who dislike us. We will have clients who hang onto our every word as gospel truth and others who second-guess us with Dr. Google.

While most will fall somewhere between extremes, it is likely that each of us at some point in our careers will have at least one interaction with a truly disturbed, overwrought, abusive client. The client may even be pathological. Let's develop training and resources to cope with such events and be supported; to not allow them to define us; and most importantly, to know how and when our own actions and words might provide further fuel for these fires. I want to be clear that the victim is never responsible for the abuse, and is not to be blamed. However, in escalating situations, we need to have the awareness that our tone, our need to be right, our need to point out another's failings and our actions may move a relatively benign, if uncomfortable, encounter into a damaging one that takes on a life of its own.

Finally, it may be time to rethink how we individually and as a profession have promoted the concept of the “human/companion-animal bond.” While an attached client is often willing to spend the considerable financial resources necessary for advanced veterinary care, referring to dogs and cats as “fur babies” and “kids” and clients as “Mom” and “Dad” carries an inherent risk. It has considerably raised the emotional ante of our work, at least for a subset of clients.

In an increasingly isolating society with a segment of the population disconnected from others and lacking human relationships, such thinking can be a tinderbox. I see much effort devoted to “celebrating” the bond, but little given to enhancing our understanding of the growing body of literature on attachment and attachment disorders. Consider this: We personally may have enjoyed healthy attachments to humans and companion animals throughout our lives, but a particular client may not have been so fortunate. In a worst-case scenario with disordered attachment, the animal may take on such critical importance that chronic illness and death become catastrophes. In such a circumstance, the veterinary clinician might be in the crosshairs of a client’s extreme reaction.

Many veterinarians are angry now about Shirley’s impossible situation and are seeking ways to help other colleagues avoid the stresses that overwhelmed her. Let us remember that there are two kinds of anger: that which seeks only to hurt, shame and revile, which ultimately consumes us; and a type sometimes called “righteous,” which serves as a catalyst for change. Amidst our outward anger, let us not miss the opportunity to look at ourselves with compassion and insight. By melding external force with internal awareness, we’ll have a potent combination that will benefit many and each of us.

About the author: Michele Gaspar is a 1994 graduate of the University of Wisconsin School of Veterinary Medicine and a diplomate of the American Board of Veterinary Practitioners (Feline Specialty). She has a Master's in pastoral counseling from Loyola University/Chicago and is a staff therapist at the CG Jung Center in Evanston, Ill. Michele is a full-time employee of VIN, where she serves as a consultant in feline internal medicine and facilitates mindfulness meditation training for veterinarians. She also is a member of Vets4Vets, a VIN Foundation-sponsored group that provides support to colleagues with professional and personal issues. Michele's professional interests include using her psychodynamic training to bring awareness of psychosocial issues to veterinary medicine, developing useful resources and helping veterinary colleagues navigate the all-too-ignored mental issues that prevent enjoyment of and fulfillment in what she considers to be one of the best helping professions. She shares her home in Chicago with one very understanding husband, Dave Elsner, four bassets, four cats and a tankful of engaging fish.

VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email news@vin.com.